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Trial registered on ANZCTR


Registration number
ACTRN12618001474246
Ethics application status
Approved
Date submitted
24/08/2018
Date registered
3/09/2018
Date last updated
3/09/2018
Type of registration
Prospectively registered

Titles & IDs
Public title
Perioperative analgesia for elective total hip arthroplasty
Scientific title
Perioperative analgesia for elective total hip arthroplasty under subarachnoid anesthesia with opioids: comparison between epidural, femoral nerve block, FICB (fascia iliaca compartment block), femorocutaneous nerve block and psoas block techniques.
Secondary ID [1] 295892 0
none
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Perioperative analgesia for elective total hip arthroplasty 309358 0
Condition category
Condition code
Anaesthesiology 308226 308226 0 0
Pain management

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Patients scheduled for total hip arthroplasty under spinal anesthesia enrolled during preoperative anesthesia consultation.
Written informed consent obtained from all patients willing to participate in this study.
All patients will receive subarachnoid anesthesia in the sitting position at L3–4 or L4–5 interspace, with a 25-gauge Whitacre needle. We administer 0.5% hyperbaric bupivacaine (Hyperbaric bupivacaine 0.5% 'Registered Trademark', Braun) according to the following formula: bupivacaine (mg) = height (cm) x 0.07, with morphine (Morphine 0.1% 'Registered Trademark',, Braun) 0.15 mg and fentanyl (Fentanest 'Registered Trademark', Kern Pharma) 15 microg. Following injection, patients are immediately kept on lateral decubitus for 6 minutes to improve analgesia.
There are 10 groups:
- control group (without additional blocks).
- epidural analgesia group (the subarachnoid anesthesia in these patients will be performed through the epidural needle at L3-4 or L4-5, the catheter advanced 3-4 cm and levobupivacaine (Chirocane 'Registered Trademark', Abbvie) 0.1% + fentanyl 2 microg.mL-1 (infusion rate 6-10 mL.h-1, bolus volume 5 mL, lock interval 30 min). Epidural infusion is started at the end of surgery.
- femoral nerve block with 20 ml of levobupivacaine 0.375%, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- femoral block with 20 ml of levobupivacaine 0.375% and dexamethasone (Fortecortin 'Registered Trademark', Merck) 4 mg, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Fascia Iliaca Compartment Block with 20 ml of levobupivacaine 0.375%, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Fascia Iliaca Compartment Block with 20 ml of levobupivacaine 0.375% and dexamethasone 4 mg, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Femorocutaneous nerve block with 10 ml of levobupivacaine 0.375%, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Femorocutaneous nerve block with 20 ml of levobupivacaine 0.375% and dexamethasone 4 mg, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Psoas block with 20 ml of levobupivacaine 0.375%, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.
- Psoas block with 20 ml of levobupivacaine 0.375% and dexamethasone 4 mg, performed 7-10 minutes after spinal anesthesia, when the patient is placed supine again.

Surgeons and anesthesiologists are blinded to the addition of dexamethasone (perineural medication is prepared by a nurse adding 4 mg of dexamethasone or 1 ml of saline according to the randomized protocol).
Nerve blocks are single-shots techniques performed under both ultrasound and nerve stimulation (considered adequate at 0.2-0.5 mA) by experienced anesthesiologists.
All patients receive a standardized postoperative IV treatment: metamizole magnesium 8g/24 h, dexketoprofen 50 mg/12h. Postoperative analgesia begins immediately at the end of the surgery, when the patient is admitted to the PACU.
The primary outcome, pain, is measured every hour (respecting the sleep period) during 24 h using a verbal rating 11–point scale for patient self-reporting of pain (VRS-11) previously explained to the patients: from 0 (“no pain”) to 10 (“the most horrible pain you can imagine; such as being burned alive”), and they are also advised to notify their nurse if they feel pain.
Rescue analgesia when needed include:
1st: paracetamol 1 g, maximum 1g/6h/IV
2nd: Morphine 2 mg/15 min, maximum 10 mg/4h/IV Rescue blocks: FICB and epidural
Intervention code [1] 312221 0
Treatment: Drugs
Comparator / control treatment
The control group receive subarachnoid anesthesia only, without additional blocks
Control group
Active

Outcomes
Primary outcome [1] 307194 0
Pain, assessed. using a verbal rating 11–point scale for patient self-reporting of pain (VRS-11).
Timepoint [1] 307194 0
every hour for 24 hours post surgery completion
The patients are also advised to notify their nurse if they feel pain in every moment
Secondary outcome [1] 351070 0
Hypotension (systolic blood pressure is lower than 75% of basal value) measured with Post-Anesthesia Unit patient's monitors with readings displayed on the monitoring screen.
Timepoint [1] 351070 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [2] 351071 0
bradycardia (heart rate) less than 60 beats per minute measured with Post-Anesthesia Unit patient's monitors with readings displayed on the monitoring screen.
Timepoint [2] 351071 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [3] 351072 0
arrhythmias measured with Post-Anesthesia Unit patient's monitors with readings displayed on the monitoring screen.
Timepoint [3] 351072 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [4] 351073 0
postoperative nausea evaluated by means of a 4-point verbal descriptive scale (VDS) (0=no nausea, 1=mild, 2=moderate, 3=severe).
Timepoint [4] 351073 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [5] 351074 0
vagal syndromes: sudden appearance of bradycardia, dizziness and cold sweats.
Bradycardia (heart rate) less than 60 beats per minute measured with Post-Anesthesia Unit patient's monitors with readings displayed on the monitoring screen, and dizziness and cold sweats by clinical evaluation of the patient in the PACU by the nurse and/or anesthesiologist in charge.
Timepoint [5] 351074 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [6] 351075 0
sedation measured with Ramsay sedation score
Timepoint [6] 351075 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [7] 351076 0
restlessness evaluated by means of a 4-point verbal descriptive scale (VDS) (0=no, 1=mild, 2=moderate, 3=severe)
Timepoint [7] 351076 0
time period admitted in the PACU: every hour for 24 hours post surgery completion
Secondary outcome [8] 351077 0
bleeding: postoperative losses are calculated based on hematocrit and hemoglobin variations in 3 blood tests (1, 8 and 20 hours after surgery)
Timepoint [8] 351077 0
time period admitted in the PACU: every hour for 24 hours post surgery completion the bleeding by the drainages is quantified, and postoperative losses are calculated based on hematocrit and hemoglobin variations in 3 blood tests (1, 8 and 20 hours after surgery)
Secondary outcome [9] 351288 0
postoperative vomiting evaluated by means of a 4-point verbal descriptive scale (VDS) (0=no nausea, 1=mild, 2=moderate, 3=severe).
Timepoint [9] 351288 0
time period admitted in the PACU: every hour for 24 hours post surgery completion

Eligibility
Key inclusion criteria
Patients scheduled for total hip arthroplasty
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
unicompartmental hip arthroplasty, refusal to participate, contraindication to spinal or regional anesthesia and/or allergy to the drugs used

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is made by our Statistical Department
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Phase 4
Type of endpoint/s
Efficacy
Statistical methods / analysis
significance level (alpha): 0.05 in a two-sided test power: 1.000
total sample size: 500 patients
number of groups: 10
effect size: 0.9
Software used: I.B.M. SPSS
Normality of the quantitative parameters: Kolmogorov-Smirnov test.
Comparison of means of independent samples: ANOVA, followed by Dunnett’s test for post hoc testing. Repeated measures ANOVA is used for paired data.
Association between qualitative variables: chi-square test with Fisher’s exact test where appropriate. Trends are studied with the chi-square for linear trend test.

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
1/10/2018
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
500
Accrual to date
Final
Recruitment outside Australia
Country [1] 20797 0
Spain
State/province [1] 20797 0
Navarra, Madrid

Funding & Sponsors
Funding source category [1] 300486 0
Hospital
Name [1] 300486 0
Hospital Complex of Navarra (Complejo Hospitalario de Navarra)
Country [1] 300486 0
Spain
Primary sponsor type
Hospital
Name
Hospital Complex of Navarra (Complejo Hospitalario de Navarra)
Address
Irunlarrea St, 3,
31008 Pamplona,
Navarra
Country
Spain
Secondary sponsor category [1] 299960 0
None
Name [1] 299960 0
Address [1] 299960 0
Country [1] 299960 0

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 301286 0
University Hospital Puerta De Hierro Majadahonda Clinical Research Ethics Committee
Ethics committee address [1] 301286 0
Manuel de Falla St, 1,
28222 Majadahonda,
Madrid
Ethics committee country [1] 301286 0
Spain
Date submitted for ethics approval [1] 301286 0
Approval date [1] 301286 0
22/01/2018
Ethics approval number [1] 301286 0
“ANALGESIA POSTOPERATORIA EN LA ARTROPLASTIA TOTAL DE CADERA. ESTUDIO COMPARATIVO, PROSPECTIVO Y ALEATORIZADO”. Acta nº 01.18.

Summary
Brief summary
Analgesia in total hip arthroplasty is important to reduce the incidence of postoperative chronic pain.
This prospective, randomized trial compares several regional alternatives to subarachnoid anaesthesia (the most common technique).
All of these interventions are widely used in routine clinical practice to improve analgesia, but there is not enough data to establish which of them is the most adequate to treat pain.
Trial website
Trial related presentations / publications
Public notes
Attachments [1] 3038 3038 0 0
/AnzctrAttachments/375859-PI_177-17_Aprobación.pdf (Ethics approval)

Contacts
Principal investigator
Name 86494 0
Prof Jose Ramon Ortiz Gomez
Address 86494 0
Service of Anesthesiology. Hospital Complex of Navarra. Irunlarrea St, 3,
31008 Pamplona,
Navarra
Country 86494 0
Spain
Phone 86494 0
+34 848 42 22 22
Fax 86494 0
Email 86494 0
[email protected]
Contact person for public queries
Name 86495 0
Jose Ramon Ortiz Gomez
Address 86495 0
Service of Anesthesiology. Hospital Complex of Navarra. Irunlarrea St, 3,
31008 Pamplona,
Navarra
Country 86495 0
Spain
Phone 86495 0
+34 848 42 22 22
Fax 86495 0
Email 86495 0
[email protected]
Contact person for scientific queries
Name 86496 0
Jose Ramon Ortiz Gomez
Address 86496 0
Service of Anesthesiology. Hospital Complex of Navarra. Irunlarrea St, 3,
31008 Pamplona,
Navarra
Country 86496 0
Spain
Phone 86496 0
+34 848 42 22 22
Fax 86496 0
Email 86496 0
[email protected]

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